Recognizing and treating sleep disorders in women

Women have different sleep needs, so sleep disorders affect them differently

GETTING ENOUGH SLEEP PLAYS A CRUCIAL ROLE in keeping both minds and bodies healthy. However, one in three adults — or about 84 million people — struggle with sleep problems that prevent them from getting the 7-9 hours they need each night.¹ For a variety of reasons, women are less likely than men to enjoy the benefits of regular and restorative sleep.² 

Hormonal changes

Fluctuating levels of hormones — throughout the month and over her lifetime — can alter a woman’s circadian rhythm, increasing her likelihood of experiencing insomnia.³ One in four women has symptoms, such as difficulty falling asleep, waking up too early or feeling unrested.⁴  

• Pregnancy. Hormonal shifts — as well as frequent urination, breast tenderness, backaches and more — can contribute to sleep problems while a woman is pregnant. Some women also struggle with sleeplessness after their babies are born due to decreasing hormone levels combined with the demands that come with caring for a newborn. 
• Menopause. The prevalence of insomnia among women also tends to spike as they age. Declining levels of estrogen and other hormones during perimenopause and menopause can result in hot flashes and night sweats that affect 75-80% of women.⁵ 
• Menstruation.⁶ One-third of women have cramps, headaches and bloating that can disrupt sleep during their menstrual cycles. Additionally, women with severe premenstrual syndrome experience increased sleepiness, fatigue and trouble concentrating. 

Health factors

Multiple health problems that tend to affect more women than men could contribute to sleep issues, including: 

• Conditions associated with chronic pain.⁷ Migraine, tension headaches, arthritis, heartburn and fibromyalgia are more common among women and can result in pain-related sleep problems. 
• Restless legs syndrome (RLS).⁸ Women are twice as likely as men to have RLS, which causes unpleasant tingling sensations in the legs when lying down that can only be relieved through movement. What’s more, the risk for RLS is higher among women with multiple children and increases from pregnancy to menopause. 
• Nocturnal sleep-related eating disorder (NS-RED).⁹ This parasomnia where people eat food while they are asleep and do not remember doing so after waking up is significantly more likely to occur in women. 
• Sleep apnea. Although it is twice as common in men, women aged 50 and older experience an increased risk. The hormonal changes that occur during menopause trigger a rise in abdominal fat and lower progesterone levels, making sleep apnea more likely.¹⁰ 

Stress and mental health

Women are nearly twice as likely as men to be diagnosed with depressionxi and experience anxiety disordersxii that can stymie their sleep.  

Furthermore, women still handle most of the household tasks such as laundry, cleaning and meal preparation despite the fact they comprise nearly half of the workforce in the United States.¹³ Without adequate time to relax and recharge, women can reach a state of profound physical, cognitive and emotional fatigue. In other words, they become exhausted. 

Many of us, including myself, have been driven to the point of exhaustion. My hectic schedule has prevented me from getting the sleep I needed and created a perfect storm for sleep deprivation. However, experiencing the symptoms firsthand further inspired me to help women — and their chiropractors — recognize and remedy sleep problems. 

Signs of sleep deficiency

To better enable patients to achieve whole body health naturally and noninvasively, chiropractors must be able to identify the symptoms of insufficient sleep — especially in women, who are more likely to experience it.  

Just one night of tossing and turning can affect how a patient feels during their waking hours. They may exhibit:¹⁴ 

• Daytime sleepiness 
• Lack of energy 
• Trouble focusing 
• Slow thinking 
• Mood changes, including feelings of stress, anxiety and irritability 
• Impaired memory 
• Poor decision-making 

Practitioners should also pay attention to some physical attributes that may indicate their patients are having trouble sleeping, including:¹⁵ 

• Eyes. Patients who are not getting enough sleep may exhibit redness, puffiness, droopy eyelids, dark circles and bags around their eyes. 

• Weight. Without enough sleep, the body cannot properly control the hormones that affect hunger, including ghrelin and leptin. This may cause patients to eat more than they need, resulting in weight gain. 
• Skin. Sleep helps regulate the hormones needed for skin to rebuild and remain elastic. A patient’s skin can appear sallow and dull when this process is disrupted. Some studies have found a link between a lack of sleep and acne that could also be related to how sleep controls hormones in the body.¹⁶ 
• Vital signs and reflexes. While changes in vital signs related to sleep deprivation usually are not very apparent, those that may be affected include body temperature, blood pressure, heart rate and breathing rate. Patients may also exhibit abnormal reflexes like slow corneal reflexes and oversensitive gag and deep tendon reflexes.  

If a patient is regularly missing sleep, they may be suffering from some of the more serious long-term consequences of chronic sleep deprivation, such as: 

• Obesity 
• Type 2 diabetes 
• High blood pressure 
• Heart disease 
• Stroke 
• Dementia 
• Poor mental health 

Treatment and prevention of sleep problems

If a patient is exhibiting signs of sleep deficiency, the first step chiropractors should take is simply to start a conversation. Ask questions about: 

• Sleep quantity. How many hours does the patient sleep each night? Are they getting the necessary 7-9 hours? The average adult woman sleeps eight hours and 27 minutes per night.¹⁷ This is 11 more minutes than men even though they have less time for sleep due to more demanding family and social roles. 
• Sleep quality.¹⁸ Although they get more sleep overall, women don’t tend to sleep as well as men, possibly because they are more likely to experience interruptions like children waking up in the night. As such, it is especially important to inquire if female patients are regularly getting the restorative sleep needed to maintain their health. Signs their sleep quality needs improvement include: 
• Taking more than a half hour to fall asleep after getting in bed. 
• Regularly waking up at night.  
• Lying awake for more than 20 minutes after waking up in the middle of the night. 
• Spending less than 85% of time in bed asleep. 
• Not feeling rested upon waking up in the morning — even after getting 7-9 hours. 

Next, try to determine what might be causing problems with a patient’s sleep quantity, quality or both, keeping factors such as their age (especially women) and other health conditions in mind. For instance, if a patient is experiencing stiffness or sore muscles, ask them about where they sleep.  

Are they sleeping on a couch, recliner or an old mattress that is not offering adequate support? If they are struggling with chronic pain in the spine, neck or hips, or they are experiencing migraines, chiropractic adjustments may provide relief and in turn, help them sleep better.¹⁹ 

Recommending certain lifestyle changes may also improve a patient’s sleep, such as: 

• Bedtime routine: Patients should try to go to bed around the same time every night, make their bedroom as quiet and dark as possible to minimize disruptions, and avoid electronic devices for at least an hour before bed. 
• Caffeine consumption: Because caffeine from beverages like coffee, energy drinks and tea can remain in a person’s system for several hours, patients should stay away from it in the afternoons and evenings. 
• Exercise: Regular exercise can boost sleep quantity and quality. However, vigorous exercise within one hour of bedtime may delay sleep, affect sleep quality and lead to more nighttime awakenings, especially for people with insomnia who are advised to exercise at least four hours before bedtime.²⁰ 

Depending on what is causing the patient’s sleeping problem, consider suggesting other treatment modalities outside of chiropractic care such as acupuncture²¹ and natural sleep aids²² like melatonin, magnesium and valerian root. 

Different sleep issues afflict many women throughout the various stages of their lives. Fortunately, chiropractors can help by identifying the problem, determining the cause, and providing or recommending treatment.

KRISTINA PETROCCO-NAPULI, MS, DC, DHPE, FICC, is dean for the College of Chiropractic at Logan University in Chesterfield, Mo. Women’s health, especially related to natural health care plans, has been her focus for more than two decades. She is the immediate past and founding president of the American Chiropractic Association’s Council on Women’s Health and has been instrumental in the founding and continuation of Logan University’s Women’s Health Symposium, which is now in its fourth year.

REFERENCES 

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